Please put your name EXACTLY AS IT APPEARS on your repeat slip.

First Name(s):   (necessary)

 Family Name:  (necessary)

Date of Birth (in form dd.mm.yy): (necessary)

Home telephone: Work Phone:

Mobile Phone:

EMail: (necessary)

Please understand, medications can only be ordered via this system if there are still Authorised In date repeats on your last repeat slip.

Please specify repeats required EXACTLY as they appear on your Repeat Slip on the right hand side of your Prescription.

1st Repeat Medication Required: Strength:

2nd Repeat Medication Required: Strength:

3rd Repeat Medication Required: Strength:

4th Repeat Medication Required: Strength:

5th Repeat Medication Required: Strength:

6th Repeat Medication Required: Strength:

7th Repeat Medication Required: Strength:

8th Repeat Medication Required: Strength:

If you require more than 8 items at any one time, you will have to submit this form, then recomplete and submit a second batch of repeats.

How I get my repeats:  (check one of six choices)

 I collect my repeats already dispensed by the Filey Surgery Dispensary   

I collect my repeat prescription and take it myself to the chemist of my choice for dispensing  

I collect my Repeat Medication directly from  Moss's on Murray Street opposite the HSBC Bank in Filey- Mr Sutherland's old shop   

I collect my Repeat Medication directly from  Selles on Murray Street opposite the Post Office in Filey  

I collect my Repeat Medication directly from  Richardson's Chemist on Belle Vue Street  in Filey   

I collect my Repeat Medication directly from  Moss's in Hunmanby- Mr Breffitt's old shop    

I  understand that E Mail is not totally reliable, nor definitely confidential. 

I absolve the Surgery Dispensary from any problems that arise through use of this OnLine requesting. 

Click here to accept these terms and submit your request for repeats.